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[The spectrum of Lyme borreliosis from the dermatologic viewpoint].

Erythema chronicum migrans, lymphadenosis benigna cutis and acrodermatitis chronica atrophicans represent the dermatological manifestations of the multi-organ disease Lyme borreliosis. Koch's requirements of evidence for an infectious disease, demonstration of the bacterium, transfer, and culture have proven Borrelia burgdorferi to be the causative agent of the above mentioned skin diseases. This justifies a penicillin therapy, that has been administered in Europe empirically for the last 30 years. Correct and prompt diagnosis is important since delayed treatment is less effective, presumably because the spirochete becomes sequestered in immune-privileged sites. Recent observations in several laboratories that antibody titers to Borrelia burgdorferi are also elevated in several other skin diseases and that the spirochete can be detected in tissue sections of different organs may imply extension of the dermatological spectrum of Lyme disease. The significance of these findings in such heterogeneous diseases as morphea, lichen sclerosus et atrophicans, etc. however awaits final examination.

Acrodermatitis↗
PubMed1986

Interrelationships between zinc and immune function.

Zinc deficiency is a common nutritional problem observed both in human and in animal populations that has profound effects on host defense mechanisms. Using the young adult mouse as a model, it has been demonstrated that a moderate period of suboptimal zinc causes thymic atrophy, lymphopenia, and alterations in the proportions of the various subsets of lymphocytes and mononuclear phagocytes. As a result, antibody-mediated responses to both T cell-dependent and T cell independent antigens are significantly reduced. Cytolytic T cell responses, natural killer (NK) cell activity, and delayed-type hypersensitivity (DTH) reactions are also depressed. Suboptimal zinc during in utero development of mice causes persistent states of immunodeficiency in the offspring that can even be transferred to subsequent generations. In regard to human immunological consequences of zinc deficiency, patients with the genetic disorder of zinc absorption, acrodermatitis enteropathica, also exhibit atrophic thymuses, lymphopenia, anergic DTH responses, and reduced NK cell activity. Patients suffering from sickle cell anemia or uremia with associated deficiencies in zinc exhibit similar immune deficiencies. An additional outcome of these studies has been shown to be an essential cofactor for thymulin, one of the thymic hormones. Furthermore, addition of zinc salts to culture can polyclonally activate lymphocytes as well as augment responses to mitogens in adjuvant-like manner.

Acrodermatitis↗
PubMed1987

Symptomatic zinc deficiency in a breast-fed, premature infant.

Hypozincemia and clinical features of acrodermatitis enteropathica developed in a breast-fed, premature infant at 6 months of age. Maternal breast milk zinc levels were normal at birth and at the time of appearance of zinc deficiency in the infant. Zinc supplementation administered orally resulted in rapid improvement. Seven premature infants with hypozincemia and transient symptomatic zinc deficiency have been previously described. In contrast with this case, the other infants received feedings with low zinc content.

Acrodermatitis↗
PubMed1986

[Borrelia-associated dermatoses].

Erythema chronicum migrans (E.c.m.), Acrodermatitis chronica atrophicans (A.c.a.) and Lymphadenosis benigna cutis (L.b.c.) are infectious diseases according to Koch's criteria, after the infectious agent-Borrelia-Burgdorferi-could could be isolated. Clinic, pathology and therapy of these three diseases are presented in detail. The correlation to the lyme disease is being discussed. We believe that E.c.m., A.c.a. and L.b.c. are different entities determined by the virulence of the infectious agent and the individual immunological response.

Acrodermatitis↗
PubMed1986

[Enlarged spectrum of tick transmitted spirochaetoses].

After the successful identification of Borrelia burgdorferi as the cause of Lyme disease, a new tick-borne infection occurring in the United States, almost identical spirochaetes have been isolated from the tick Ixodes ricinus in Europe. As a result, the spirochaetal aetiology of skin diseases, which had long been recognized as tick-borne infections, namely erythema chronicum migrans with its neurological complications of the tick-borne meningopolyneuritis of Garin-Bujadoux-Bannwarth, acrodermatitis chronica atrophicans and lymphadenosis cutis benigna, could be confirmed by means of microbiological, histological and serological methods. On the basis of case histories it had already been assumed for some time that anetodermia maculosa and the localised sclerodermas might also be caused by a tick-borne agent. The results of serological investigations have now strengthened this assumption, although microbiological confirmation is still lacking.

Acrodermatitis↗
PubMed1985

Functional consequences of zinc deficiency.

Zinc is an essential trace element necessary for over 200 zinc metalloenzymes and required for normal nucleic acid, protein, and membrane metabolism. During the past two decades there has been a rapid expansion of knowledge concerning zinc metabolism in both normal and disease situations, including mechanisms for zinc absorption, excretion and internal redistribution of zinc after stress or trauma. Acrodermatitis enteropathica has been recognized to be a disease of impaired zinc absorption in man. A host of disease processes now are recognized to be complicated by zinc deficiency including alcoholic liver disease, sickle cell anemia, protein calorie malnutrition, and a variety of intestinal diseases including Crohn's disease, sprue, short bowel syndrome and after jejunal ileal bypass. Zinc has proved to be an extremely interesting mineral to nutritionists and physicians because of its importance in normal physiology and biochemistry and because of the diverse presenting features of zinc deficiency. This paper reviews ten functional consequences of zinc deficiency and emphasizes certain consequences in which there have been new discoveries concerning their mechanism (e.g., anorexia) or their clinical importance (e.g., immune dysfunction).

Acrodermatitis↗
PubMed1985

[Borreliosis--still a diagnostic labyrinth].

Acrodermatitis chronica atrophicans and meningo-polyneuritis Garin-Bujadoux-Bannwarth following initial erythema migrans represent infectious diseases and may lead to diagnostic misinterpretation. Three case reports illustrate the spirochetal nature of these entities usually transmitted by ticks (Ixodes ricinus).

Acrodermatitis↗
PubMed1977

[Diagnosis and therapy of the zinc deficiency syndrome during total parenteral feeding. Review with report of a case].

A 47-year-old man with ulcerative colitis developed severe zinc deficiency during longterm intravenous feeding. Early symptoms included seborrhoeic lesions in the face and scalp. Later on his general condition deteriorated, and erythema and bullae erupted in the fingers, together with an erosive area with a marked border in the perianeal and scrotal regions. The symptomatology was suggestive of zinc depletion syndrome, a recently recognised acrodermatitis-enteropathica-like disorder in patients receiving longterm total intravenous feeding. A significantly lowered serum zinc level and a prompt beneficial response to intravenous zinc therapy (20 mg Zn2+ daily for one week) substantiate the provisional clinical diagnosis. As zinc depletion is caused by a zinc free parenteral alimentation this serious complication should be avoided by adding zinc to the infusions. Serum zinc determinations should be carried out as a control of the prophylactic zinc supply. Possibly, zinc plays a role in the symptomatology of various disorders with skin and bowel symptoms.

Acrodermatitis↗
PubMed1984

[Lyme disease--another tick-borne disease in Austria].

Infection with tick-borne spirochetes (e.g. Borrelia burgdorferi) may lead to the development of erythema chronicum migrans, acrodermatitis atrophicans, meningopolyneuritis Bannwarth, and a special type of reactive arthritis named Lyme disease after the American endemic area. Since these diseases occur also in Austria, their clinical features are described in this review; a clear distinction must be made between the neurological manifestation of Lyme disease and those of tick-bite mediated early summer meningoencephalitis. Serological tests can prove that an infection with Borrelia burgdorferi has occurred. The treatment of choice is tetracyclines in the early stages of the disease.

Acrodermatitis↗
PubMed1983

The role of zinc in gastrointestinal and liver disease.

Zinc is essential for many metabolic and enzymatic functions in man. Deficiency of zinc in man has now been recognized to occur not only as a result of nutritional factors, but also in various disease states, including malabsorption syndromes, acrodermatitis enteropathica, Crohn's disease, alcoholism and cirrhosis of the liver. The deficiency state in human subjects exists as a spectrum extending from mild to severe degree. The clinical manifestations of mild zinc deficiency include oligospermia, weight loss and hyperammonaemia. Moderate zinc deficiency is characterized clinically by growth retardation, hypogonadism in males, skin changes, poor appetite, mental lethargy, delayed wound healing, taste abnormalities and abnormal dark adaptation. In severe zinc deficiency states, bullous-pustular dermatitis, alopecia, diarrhoea, emotional disorders, weight loss, intercurrent infections, hypogonadism in males and, if unrecognized, death have been observed. Zinc is needed for the functions of over 100 enzymes. It is essential for DNA, RNA and protein synthesis and, as such, is important for cell division. Zinc is an inducer of mRNA of metallothionein, a protein which may have an important role in the regulation of intestinal zinc absorption. Zinc has a specific effect on testes in animals and man. Recent reports indicate that in human subjects thymopoietin may be zinc dependent and in animal studies somatomedin may be affected adversely due to dietary zinc restriction. Zinc plays an important role in the protection of cell membrane integrity and may be protective against free radical injury. Zinc is known to compete with cadmium, lead, copper, iron and calcium for similar binding sites. In the future, a potential use of zinc may be to alleviate toxic effects of cadmium and lead in human subjects. Recent evidence suggests that thymic-dependent lymphocytes (T cells are zinc dependent. T-helper and suppressor cells, T-effector cells and T-natural killer cells appear to be zinc dependent. Zinc is also essential for some of the neutrophil functions. Thus, it appears that zinc may play an important role in immunity. One may suggest that some of the clinical features of cirrhosis of the liver, such as testicular atrophy, loss of body hair, night blindness, poor wound healing, poor appetite, susceptibility to infections and enhanced sensitivity to drugs, may be related to conditioned deficiency of zinc, future studies are required to determine whether or not zinc supplementation is beneficial to these patients.

Acrodermatitis↗
PubMed1984

[Infectious mononucleosis with skin manifestations of the Gianotti-Crosti acrosyndrome type].

A 6-year-old boy is reported with infectious mononucleosis and a monomorphous papular eruption on the face, buttocks and limbs, as described by Gianotti and Crosti. Three types of juvenile papular acrodermatitis are to be distinguished: Gianotti-Crosti's disease, the papular acrosyndrome of Gianotti-Crosti and the papular acral manifestations caused by various viral infections. But might these eruptions not rather be the cutaneous symptom of a viral affection?

Acrodermatitis↗
PubMed1982

[Zinc deficiency dermatoses. Etiology, clinical aspects and treatment].

In zinc deficiency disorders the serum zinc concentration is low and the activity of alkaline phosphatase in serum is declining. The clinical picture includes a poor general condition and a characteristic dermatitis on hands, feet, in the face, and the anogenital region. In acute zinc deficiency, the eruption is vesico-bullous, in the chronic state parakeratotic psoriasiform. Widespread exzéme craquelée is an additional feature of the clinical picture, as seen in cirrhotics with acquired zinc deficiency. Alopecia, Beau lines on the nails, and hair changes may develop. In severe cases zinc therapy usually in the form of zinc sulphate may be administered i.v. (10-20 mg Zn daily). Oral zinc therapy is initially given in high doses (145-150 mg Zn daily). Long-term high zinc doses may interfere with copper metabolism and are only indicated for acrodermatitis enteropathica.

Acrodermatitis↗
PubMed1978

Acquired zinc deficiency dermatosis in man.

We encountered two cases of acquired zinc deficiency. In one of the patients the state was due to alcoholism with liver cirrhosis and pancreatitis, and in the other patient it was attributed to a small intestine bypass operation for obesity. The skin symptoms included hair loss, acrodermatitis, and widespread eczema craquelé (asteatosis). The cutaneous manifestations of zinc deficiency seem to constitute a characteristic syndrome that might be helpful in recognizing manifest zinc-deficient states in man.

Acrodermatitis↗
PubMed1995

[Lyme borreliosis in hand surgery. A case report].

The clinical courses of Borrelia burgdorferi infections may show such variety, that diagnostic problems arise. On the other hand, early antibiotic therapy is necessary in order to prevent late-term complications. In this article, we present an exceptional case of a long-term documentation of Lyme-disease which was not diagnosed until an acrodermatitis chronica atrophicans had developed. Whether the manifestation of bilateral carpal tunnel syndrome is connected with Lyme borreliosis is yet to be clarified.

Acrodermatitis↗
PubMed1995

Diaper dermatitis. How to treat and prevent.

Dampness, maceration, fecal enzymes, chemicals, and other irritants lead to diaper dermatitis in infants. Most cases can be cleared with frequent diaper changes, use of superabsorbent disposable diapers (which contain gelling material in their core), and a low-potency topical corticosteroid. If the eruption lasts for more than 3 days or classic erythematous satellite lesions are present, addition of an antifungal agent should help resolve the condition. Recalcitrant or clinically atypical eruptions may signify rarer disorders, such as psoriasis, Langerhans' cell histiocytosis, Leiner's disease, or acrodermatitis enteropathica. Patients with these conditions should be referred to a dermatologist, if possible, for further evaluation and treatment.

Acrodermatitis↗
PubMed1995

[The dermatologic spectrum of Lyme borreliosis].

The classical symptoms of Lyme borreliosis (LB) on the skin, erythema migrans, borrelia lymphocytoma and acrodermatitis chronica atrophicans (ACA) can be diagnosed clinically. In atypical cases, however, the diagnosis of a Borrelia burgdorferi (Bb) infection is based on the isolation of this bacterium from affected tissues. In early Lyme disease problems are arising in complicated erythema migrans which may represent reinfection, or with a failure of antibiotic treatment in some patients. The pathological changes in ACA presumably result from a chronic T-cell-mediated tissue injury with atrophy or sclerosis of connective tissue. On the other hand the presence of numerous plasma cells indicates activation of the humoral immune system where a progression into a malignant B-cell lymphoma is possible. In the recent past Bb could be cultivated from skin biopsies of a series of dermatoses of unknown origin, such as circumscribed scleroderma, dermatomyositis-like syndrome, relapsing nodular panniculitis, granuloma anulare and roseolar erythemas. New therapeutic strategies by administering antibiotics have been found to be effective in the described Bb induced dermatoses. Future studies should be focused on new standardized diagnostic procedures which make it possible to define the spectrum of dermatoses associated with a Bb infection.

Acrodermatitis↗
PubMed1995

[Lymphocyte proliferation test in cutaneous manifestations of Lyme borreliosis].

The humoral immunoreactivity in Lyme borreliosis is a well characterized parameter for establishing the diagnosis of a Borrelia burgdorferi (Bb) infection. Since patients with seronegative Lyme borreliosis have been described, lymphocyte proliferation tests may be used for detecting patients who only develop a cellular immunoreactivity against Bb organisms. We performed a the lymphocyte proliferation assays in order to determine the cellular immunoreactivity to these spirochetes in given patients with histologically confirmed diagnosis of erythema migrans (EM), acrodermatitis chronica atrophicans (ACA), and for control purposes patients with Lyme disease non associated dermatoses (NLDH) and healthy volunteers (G). Stimulation index was defined as 3H thymidine-uptake in peripheral mononuclear cells, calculated as quotient dpm (stimulated cells)/dpm (unstimulated cells) (dpm = disintegrations per minute). Stimulation indices > 10 were considered positive. We detected elevated cellular immunoreactivity of peripheral mononuclear cells in 33% EM-patients (3/9) and in 23% (3/13) ACA patients tested. Patients tested before and after antibiotic therapy showed a significant decrease of stimulation index after antimicrobial treatment (p < 0.05). Patients the EM, who are mostly seronegative at the onset of cutaneous eruption exhibit in a third of patients an elevated cellular immune response to Bb. Therefore lymphocyte proliferation assays can be recommended as an additional test system in case of lack of serological response. The significant decrease of stimulation index after antimicrobial therapy indicates for downregulation of the cellular immune response to these spirochetes investigated, and counts for the specificity of this test system.

Acrodermatitis↗